Abstract Introduction Acute kidney injury during pregnancy is a rare but serious complication associated with increased maternal and fetal morbidity and mortality. It presents diagnostic and therapeutic challenges due to physiological changes in pregnancy and overlapping conditions. Prompt recognition and multidisciplinary management are vital for improving outcomes. Case report A 30-year-old female with obesity (BMI 34.7), a history of unprovoked deep vein thrombosis complicated by pulmonary embolism in 2017, miscarriage in 2018, and Sjogren syndrome. Presented at 10 weeks of gestation with nausea, vomiting, and altered mental status, prompting admission to the Critical Care Unit for further management. Upon evaluation, severe acute kidney injury (AKI) was noted with a creatinine level of 4.9mg/dL (baseline 0.9). severe electrolyte abnormalities including hypokalemia (2.1 mmol/L), hypophosphatemia (1.4 mg/dL), uremia, metabolic alkalosis, and hypermagnesemia (4.0 mg/dL). Mild anemia (Hb 9.4 g/dL) and positive influenza A were also noted. Initial imaging including chest X-ray and neurological workup (CT, MRI brain, lumbar puncture) showed no acute pathology. A multidisciplinary team provided close monitoring and targeted therapy, leading to correction of electrolytes, resolution of alkalosis, and improvement in mental status. Discussion Pregnancy-related AKI (PRAKI) is an uncommon but critical condition characterized by abrupt kidney function loss causing metabolic and volume disturbances. Common causes include preeclampsia, sepsis, hemorrhage, and autoimmune diseases. Early intervention, including dialysis when needed, improves survival; delayed treatment correlates with higher mortality. This patient’s complex background with autoimmune disease and prior thromboembolism, added management challenges. Her recovery after timely fluid and electrolyte replacement emphasizes the importance of rapid supportive care. This case highlights the need for coordinated multidisciplinary management to optimize outcomes in pregnant patients with multifactorial illnesses. References: 1/Kidney Disease Improving Global Outcome : KDIGO clinical practice guideline for acute kidney injury.2012.Kidney Inter 2/Hildebrand A.M., Liu K., Shariff S.Z., Ray J.G., Sontrop J.M., Clark W.F., et. al.: Characteristics and outcomes of AKI treated with dialysis during pregnancy and the postpartum period. J Am Soc Nephrol 2015; 26: pp. 3085-3091. This abstract is funded by: None
Tayyab et al. (Fri,) studied this question.